Pamela and all,
I think the problem is not black and white.
There can be what some are calling “faux” ties and various interventions such as positioning and bodywork can help. In reality I see many tongue ties. Where I practice, New York City, we have various providers who release tight frenula - th problem is that many health care providers who release tongues do an incomplete or generally poor job. I send my moms to a small group of professionals.
The parents who see other providers are left without results. I see results in almost everyone of the families I see if they see my recommended providers.
It is very frustrating for sure.
There needs to be consistent training for the entire team - I can dream, right?
Leigh Anne O'Connor, IBCLC
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www.leighanneoconnor.com
www.mamamilkandme.com
www.womenwordsandtransitions.com
(917) 596-3646
Date: Sun, 26 Jul 2015 12:35:18 +0100
From: Pamela Morrison <[log in to unmask] <mailto:[log in to unmask]>>
Subject: AAP statement of Tongue Tie is AHRQ
I'm _still_ following this subject with great interest because I
remain conflicted between what I've _seen_ (tongue ties that exist
but which don't cause breastfeeding difficulties) and what I _hear_
from many of my colleagues (how consistently tongue tie severe enough
to interfere with function actually occurs). In the meantime it's
impossible to ignore the many anecdotal reports of so many tongues
and upper lips that have been revised/divided/snipped without any
resolution whatsoever of the original breastfeeding problem, showing
that in fact TT was not the cause and raising the tantalizing
possibility that other interventions would more likely have been more
effective.
It doesn't seem to be true that the IBLCE still requires no education
on this topic. There are good sections on ankyloglossia in the Core
Curriculum for LC Practice, and Breastfeeding Management for the
Clinician, Using the Evidence, to name just a couple of the most up
to date texts. I will be sitting the IBLCE exam again on Tuesday and
I confess to more than a little curiosity about how many questions
will actually be devoted to this topic, to indicate what importance
IBLCE gives to it. Personally, I wish they'd issue a statement on
ankyloglossia. Never has the adage, "If it ain't broke, don't fix
it" had more meaning than on the subject of ankyloglossia. There is
so much division in professional opinion and it's not helpful to make
allegations of ignorance or professional incompetence about IBCLCs
like me who are cautious.
Some of us want much more precise definitions about anterior ties,
posterior ties, upper and lower labial ties and lately I've just seen
a question about buccal ties possibly interfering with
breastfeeding. The credibility of our profession is being placed at
risk when we rely on unpublished anecdote rather than published
serial case histories which can attest to which types and degrees of
ties will actually require frenulotomy and which are better left
because they are not the cause of the presenting difficulty. And
clearly we, as well as AHRQ and some of the insurers, need more
research documenting not only immediate results but also long-term
outcomes, comparing the efficacy of TT division vs conventional IBCLC
interventions designed to improve positioning/latch/milk transfer,
before we'll be persuaded to ignore our own existing clinical experience.
Pamela Morrison IBCLC
Rustington, England
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